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required in the Essex districts for 87 cases of small-pox, while in West
Ham at that particular period there were 50 fresh cases of small-pox
requiring isolation.
It is obvious that with the number of beds at the proposed
Dagenham Hospital it would be quite impossible to treat so many
cases in one month, and if West Ham undertook to provide accommodation
for other districts with its existing number of beds, it could
only carry out that undertaking by neglecting to isolate cases occurring
in the Borough.
As a matter of Public Health Policy, however, it is, in my opinion,
extremely desirable if possible to endeavour in some way to arrange
that our Dagenham Hospital shall be used by the outlying districts for
all their cases of small-pox; in the first place, because the Council is
undertaking to accommodate pauper cases occurring in the West Ham
Union in order to complete the Fever Hospital at Plaistow ; but,
secondly and chiefly, because cases occurring in these districts, especially
those occurring in Leyton and East Ham, are almost as great a danger
to the Borough as if they occurred in West Ham itself; thirdly, as
will be seen from Table I., the hospital will, for several years running,
be scarcely used at all, while at the same time it must ever be maintained
in a state of efficiency and readiness to receive cases.
To meet the probable call upon the hospital resources under these
circumstances, it would be necessary to duplicate the proposed accommodation
either by raising the Pavilion to another storey or erecting a
second Pavilion similar to that already proposed. While it is a
debatable question whether or not West Ham would be justified in
thus catering for cases at a remunerative fee from the outlying districts
in its own defence on the same grounds and in the same way that the
Metropolitan Asylums Board are at present receiving West Ham cases,
such a course would entail expense not lightly to be entered upon.
It is probable, however, that the outlying districts would be
willing, in order to save the increased expenses of each providing its
own accommodation, to pay to West Ham a yearly sum towards the